Michael BuryChronic illness as biographical disruptionAbstract The paper is based on semi-structured interviews with a series ofrheumatoid arthritis patients. Chronic illness is conceptualised as aparticular type of disruptive event. This disruption highlights theresources (cognitive and material) available to individuals, modes ofexplanation for pain and suffering, continuities and discontinuitiesbetween professional and lay thought, and sources of variation inexperience.IntroductionThe purpose of this paper is to explore a limited range of theoreticaland empirical issues thrown up by the study of chronic illness. Itfocuses on a field study of rheumatoid arthritis carried out by theauthor between 1976 and 1979 in the north-west of England. The datareported here were gathered by semi-structured interviews with a seriesof thirty patients being referred, for the first time, to an outpatientrheumatology clinic. These individuals comprised twenty-five womenand five men (the disease has a four times higher prevalence amongwomen than among men). The majority of the women were agedbetween 25 and 54, two being under 24 and six being over 55 years ofage. The five men were aged between 45 and 64. Fifteen of the womenworked, either part-time or full-time. All but one were working-classwomen, with jobs such as machine operator, school kitchen worker,bakery worker and punch-card operator. All but three respondents weremarried with families, often including young children.The selective nature of this series had a purpose. The aim was to concentrate on those with an emerging illness at the earliest possible point,to explore the problems of recognition and changes in life situation andrelationships occasioned by the development of the illness. 1 thereforerelied on the identification of probable rheumatoid arthritis patientsby a consultant rheumatologist, based on referral letters from a generalpractitioner. In all but one case a definite diagnosis was subsequentlySociology of Health and IUness Vol. 4 No. 2 July 1982R.K.P. 1982 0141-9889/82/0402-0167 $1.50/1168 Buryconfirmed. The interviews were conducted once at home before attending the clinic, and again after the first two consultations. In addition,observations in the clinic setting were possible, providing informalconversations with respondents and other patients.Chronic illness as a disruptive eventAt the risk of oversimplifying, two traditions have been available tomedical sociologists interested in chronic illness. The first stems fromthe debate over the usefulness or otherwise of Parsonian conceptions ofillness and the sick-role. On a negative level, it is maintained thatchronic illness appears to deny many of Parsons assumptions about thepatterning of sickness; on a more positive note it suggests separatingand developing deviance and adaptive perspective from his theory(Gerhardt, 1979; Gallagher, 1976). This, it is hoped, will overcome thelimitations thought to arise from an overemphasis on acute illness andsick role behaviour. However, the notion of adaption is often linkedto a view of disablement as a relatively stable entity. In fact, the conditions which underpin most forms of disablement involve fluctuatingsymptoms and uncertain outcome. Taylor (1977) notes that in thechanging spectrum of disablement since the Second World War chronicillness has come to overshadow the contribution of accident and injury;see also Bury (1979) for a more general discussion of disablement.Whilst residual and permanent disabilities are implicated in conditionssuch as arthritis, the illness underlying them remains significant. AsMildred Blaxter (1976) has shown, medical definitions are central indisablement not only from the point of view of doctors concerns, butalso of patients. Whilst medical definitions may at times be seen asinappropriate in service and welfare provision, this does not displace therole of both lay and specialised medical knowledge in explaining experiences or of those behaviours associated with them. My study shows, forexample, that a chronically ill person can make adaptations to his lifestyle and still have access to periods of classic sick-role behaviour whensuch events as surgical intervention or sudden exacerbations ofsymptoms occur.The second tradition has been of an interactionist nature. As onewould expect, this has concentrated on empirical enquiry, detailing thestrategic handling of symptoms and disabilities (Davis, 1964; Wiener,1975; Strauss, 1975). The insights gained have been important, especiallyover such matters as the disclosing and disguising of symptoms, but theapproach has often been frankly descriptive, with only passing reference to wider theoretical concerns. Strauss (1975), for example.Chronic Illness as Biographical Dismption 169describes the way individuals strategically withdraw from the field